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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 <br /> APPLICATION FOR LAND USE PEfice of RMIT$Zoning Administrat�� 0 Z <br /> 3 o <br /> UT <br /> OWNER N <br /> ��"��CEPHONE <br /> v <br /> HOME ADDRESS 36 m <br /> f <br /> EMERGENCY/FIRE NUMBER �3 /©/ �p / .cr. m <br /> ROAD NAME FJ LQ <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) <br /> L/ TI [ PR // 1 `D <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ <br /> o?(Y" l a o <br /> FILLING/GRADING ❑ c n <br /> CA G UNIT ❑ SUBDIVISION Q <br /> Vis; _ <br /> STRUCTURE/ADDITION USE: � � T <' <br /> /� / y <br /> (Home/Cabin; C mercial Business; Bedroom eck; etc.) c <br /> BUILDING CONTRACTOR: rn 0� <br /> m <br /> d <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'%X 11 SHEET OF PAPER. ANY INCOMPLETE OR Q <br /> v <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 <br /> -n - , 'l <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 W <br /> ;a y <br /> CCD <br /> n/ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O cL z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m _ <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. v <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO Z <br /> BUILDINGS,ROADS, LAKE, LOT LINES. oC7 l <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. s <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS Wil) <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. Q� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. -U <br /> CONDITIONS OF PERMIT: 0 6b <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT fZJ <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 40I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. ` 10 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 0 <br /> SETBACK AREA. <br /> 5. <br /> 6. <br /> �. m � v Gip s=: "_ � <br /> .0 N C:N N O <br /> Z N N O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of m o T m <br /> = rn: m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m @ m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for thO <br /> e purpose of inspection. <br /> m <br /> SIGN HERE CD <br /> N <br /> (signature of owner or building contracto I <br /> ZONING ADMINISTRATOR (date) <br /> TOWN HIP PERMITS MAY BE REQUIRED <br />